Absent From Duty Form
1/2 day AM 1/2 day PM Whole Day
Date of Absences:Employee Name
I will be out for (select only one):
Reason for Absence (select only one)
Personal Leave
School Business - Workshop Title:
School Business - Athletics:
School Business - Non-Athletic:
Jury Duty (documentation required)
Other:
Please use the following
Local (3 days per year & only if available)
State (5 days per year + accumulated & only if available)
______________________________________________________________________________________
NOTE: Excessive leave will be handled through the Supt/Business Office. Personal leave days must be pre-approved by the
principal or supervisor. Per DEC (LOCAL), leave must be taken in 1/2 days or whole days only. Each employee must submit an
Absent From Duty form to the principal/supervisor immediately after returning to duty. A written statement from the
physician or practitioner must be submitted for an absence of five or more continuous days. This statement should appear on
this form or attached securely hereto.
1/2 day AM Whole Day
Name of Substitute
Select One:
1/2 day PM
I verify, to the best of my ability, that the above information is correct.
Signature:
______________________________________________________________________________________
Date:
Time In: Time Out:
Employee Signature
Supervisor's Signature
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signature
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signature
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